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Medicare and Long-Term Care

Medicare and Long-Term Care

As Medicare enrollees continue to age, it’s common that they, or someone they love, will need a form of long-term care to help them live happy lives. Because long-term care is so common, we often get asked about Medicare’s coverage of long-term care and how much it will pay for.

Long-term care is defined as any assistance given for a chronic disease, illness, or disability that prevents the patient from performing basic everyday tasks. How common is long-term care? Over 8,000,000 seniors receive some long-term care every year. According to the U.S. Department of Health and Human Services, around 70% of people over the age of 65 will need long-term care at some point in their life. This can be in the form of nursing homes, hospice centers, in-home care, or any more of the type of long-term aid.

In most cases, Medicare isn’t going to be paying for any long-term care that you need. Original Medicare only pays for a small portion of long-term care, it will pay for the first 100 days in a nursing home or skilled nursing facility. But they will only pay for the care if you’ve spent at least three days in the hospital. There are cases that Medicare will pay for home health care, but there are a lot of restrictions on the coverage, and they will only approve payment for four to ten hours a week of care although they can cover up to 35 hours, it’s rare that it ever happens.

The Cost Of Long-Term Care And How To Pay For It

Long-term care can carry an expensive bill. For a semi-private room in a nursing home, you’ll be looking at more than $6,000 per a month on average. The average cost of a nursing home can be a financial strain for a lot of seniors to cover, especially those without much assistance.

If you haven’t reached the stage where you need long-term care, you should start planning for the possibility of having to pay for care. Because long-term care can quickly drain a retirement account, having the funds to pay for the long-term care can keep you from having the added financial stress or leaving the bill for your loved ones to pay.

One option for paying for long-term care is buying a long-term care insurance policy offered by a private company. There are plenty of different long-term care insurance plans that offer different coverage amounts and benefits for policyholders. Most people won’t benefit from having a long-term care insurance policy because of the price of the policy. But if you think you want a policy, receive a quote from a private insurance company and weight the cost of the premiums and how long you will need the need the insurance policy, remember that the premiums are likely to increase as you age.

Another way to afford long-term care is applying for “PACE”. The Program of All-Inclusive Care for the Elderly is designed to help seniors pay for health care costs that they wouldn’t be able to afford otherwise.  The program is a part of the Medicare and Medicaid services and provides a PACE approved physician, in-home care, and a community of professionals to give the care you need. To be eligible for PACE, you must meet a few requirements, 55 years or older, living in an area that PACE services, need nursing home care, and be able to live safely in the community with PACE assistant. The program will cover expenses like hospital services, home care services, occupational therapy, prescriptions, and much more.

Medicare And Long-Term Care

Because long-term care is such a common needed service, it’s important that Medicare enrollees should plan or the possibility. There are several of different ways that you can cover the costs of many long-term services, but original Medicare isn’t one of them. Make sure that you have a strategy in place in case you need long-term care.


MedicareWallet.com is an unbiased, online resource for individuals turning 65 or already on Medicare. Our utmost goal is to provide information in a way that is user-focused, informative and ethical. With a combined 40 years of experience in the Medicare market, we can answer any questions about Medicare and Medigap insurance. Feel free to reach out to us at 800.376.0824 or by email at [email protected]

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